You are working on an inpatient psychiatry unit and one of t…

You are working on an inpatient psychiatry unit and one of the new registered nurses tells you that she is caring for a patient with a diagnosis of a manic episode with mixed features.  She asks you to explain what this means.  You advise the nurse that patients experiencing episodes of bipolar mania, hypomania, and major depression can also experience symptoms of opposite polarity (mixed features).  You explain that a manic episode with mixed features is defined as an episode that meets the diagnostic criteria for mania along with at least three of the defined symptoms being present on most days of the episode.  Which of the following is NOT included in the defined symptoms associated with a manic episode with mixed features? 

A 23-year-old patient complains of multiple physical and men…

A 23-year-old patient complains of multiple physical and mental disorders, including anxiety, irregular menses, neck pain, abdominal cramping, joint pain, frequent and painful urination, headaches, diarrhea, and abdominal distention.  Laboratory and radiologic findings have been negative.  The PMHNP recognizes these signs and symptoms as probable: